4 Reasons Nurses Are Written Up and What Happens Next

I’ll never forget the one and only time I was written up as a nurse.

I was 7 months pregnant and on call for my job as an OB nurse. My kids had all come down with a puking stomach bug and I as 5:30 PM loomed (when they would call me if they needed me to come in at 7 PM), I was praying for two things to happen: 

1) that my phone wouldn’t ring and 

2) that I wouldn’t get sick. 

Well, lo and behold, at exactly 5:30 PM, exactly two things happened: I started puking and my phone rang with a call-in. My husband had to answer the phone for me and after explaining that I was barfing my guts out, the nurse supervisor informed him that I would be written up for not giving enough notice before calling out sick. 

Awesome. 

And while hopefully you don’t experience getting written up for getting a stomach bug at 7 months pregnant on night shift when your kids are puking, Nurse Alice did sit down with Vernell Davis—a perioperative nurse and clinical nurse specialist of 17 years who has held nearly every position in healthcare you could think of, from housekeeper to administrator—to discuss some of the more common reasons nurses do get written up. 

^{This content used under license from "Ask Nurse Alice."}

From the Other Side

Before they dove into discussing the reasons nurses tend to get written up, Davis provided some insight into what goes on behind the scenes of the managers and administrators who are the ones who do the “writing up.”

“It's very tough. It's not the easiest thing to do,” Davis commented. “Because we know that we are going to be dealing with a lot of emotion. But as leaders, we look at the whole entire picture.”

She went on to describe that a manager will usually try to evaluate a few different things before deciding on a corrective action process: is there a knowledge deficit? Is there any type of way that we can educate or get any type of resource in for that individual person? Secondly, is this a behavioral issue, something that the person has done before? Is it habit? Did this person get enough orientation? Did this nurse get enough information? Do we need to mirror exactly what it is that we want in this new process? 

“So we look at a bunch of things before going to corrective action because that is the fair thing to do,” she added. 

Davis also assured us that managers and administrators are most definitely not just sitting around thinking of ways to write nurses up for fun. “We value each and every nurse that we have here at the bedside; they're caring for patients and they're taking care of the community, and we need our community taken care of because that impacts everything else,” she noted. “ Leaders are not sitting behind the desk right now trying to get rid of people; we are trying to get nurses in!”

1. Not Being on Time

While time and attendance may be the most common reasons nurses are written up, Davis did note that even this particular issue has changed a lot in the wake of the COVID-19 pandemic. For instance, childcare challenges for single parents may have led to last-minute call-ins, public transportation being shuttered, affected workers who relied on it to get to work, and virtual school schedules—it all played a role and, according to Davis, prompted healthcare administrators to adopt more of an individualized approach to addressing attendance issues. 

“Timing and attendance during COVID was a really big thing. And as a leader, we have to become extremely flexible to that,” she explained. “So it was like, ‘How can we work with you? Do we adjust your schedule and maybe give you 30 minutes more or you know, change you to a whole different shift that will work for you?’”

That being said, however, she stressed the importance of nurses realizing that if their shift starts at 7, that doesn’t mean you can roll in the door at 7 on the dot with a Starbucks in hand. “You need to be at report, at huddle listening to the information that was coming down and information that you needed to get from a bedside nurse,” she pointed out. “Huddle is the most important part of your day. Because you're getting information—you're getting the latest and greatest and then you're also sharing information with your leaders who need to escalate that. So being on time is important that you get that information and you're also able to share things because the worst possible situation a person can be in is not knowing about these changes.” 

2. Attendance Issues

As far as attendance goes, Davis explained that it’s not because leaders want to “be in your business” that they want to know about planned (or unplanned!) time off as far in advance as possible—it’s because as a nurse, you’re a valuable part of the team, and it’s the nurse leader’s job to ensure that the team can continue taking care of the community during your time away. 

She also offered the suggestion that if you’re feeling sick and waiting to see how you feel before calling into a shift, to instead, give your manager a heads up that you’re feeling ill—and then let them know if you feel up to coming in, instead of the other way around. That way, they can arrange back-up coverage ahead of time. It’s easier to call off a back-up nurse than it would be to scramble to find a replacement last-minute. 

3. Poor Communication

The third issue that nurses can run into that can lead to disciplinary action comes down to communication. Davis pointed out that at any given moment, nurses are expected to communicate in a variety of different ways: verbally, written, gathering orders from the computer, assessing patients physically and through family history and charts, interacting with other healthcare workers. There’s a lot going on and if communication breaks down at any point, there could be problems. 

But Davis explained that if the standards are set up with clear expectations for communication, if the issue comes down to an individual level with the nurse, it could be a situation that needs addressing. As an example, she presented a situation where a nurse failed to label a patient specimen. The standard was clear on what the nurse was supposed to do, but if they didn’t do it, the communication error fell with them. 

“So when that nurse is distracted and does not follow the order of sequence of collecting specimens in that protocol, that could lead down the road of corrective action because those things are already in place,” she noted. “And that is a skill that is expected for you to have as a nurse.”

4. Behavioral Standards

In an era where nurses are subjected to even more poor treatment than ever before, this one can be tough, but Nurse Alice and Davis discussed how nurses should conduct themselves professionally at work—even when that means leaving personal opinions and issues at home. 

“So what that entails is basically you should come to work, be professional, be polite and be kind to your peers and the patients and the physicians, communicate therapeutically, and come to work knowing that you are a professional and that nursing is a profession,” noted Davis. 

She added that work is not the place to communicate your personal opinions or bring what she calls “excess baggage” into a place where your job is to care for patients. “We know that there can be politics in health care, [but] as a profession, you have to know when and where and the audience to have those types of conversations,” she clarified. “Some people struggle with that. Some people struggle with bringing in the professional and leaving the personal at home. And it's really hard. So as a leader, you recognize it, and you try to talk to the individual.”

(Please note, Davis and Nurse Alice would never mean this for nurses experiencing any type of threat, violence, or abuse at work. Always, always speak up if you feel unsafe at work in any way.)  

If you are struggling at work, Davis encourages you to talk to your nurse managers and leaders about some resources that can help you. For instance, mental health resources, communication classes, or religious services may all be tools that you can use. And as a nurse leader, if you notice a nurse struggling or having frequent outbursts at work, find and offer them resources that can help. Because we all know that nurses are dealing with a lot right now. They both reiterated that there will be many formal steps taken and assistance offered before a drastic step such as termination is taken, but it is important to be aware and try to correct any sort of communication or personal and professional boundary-breaking behavior at work as soon as possible. 

“It's a teachable moment for everybody, because there may be something that comes out of that, that creates a change within the team,” she added. “That is your first step.”

Nurse Alice ended the conversation by reminding nurses that if they are struggling—whether it’s personally or professionally—to always reach out to their nurse leaders for help, because it could help identify a solution early on. And when your nurse leaders set up a meeting to discuss how to help, take advantage of that and communicate your struggles.

“It’s really an opportunity to really communicate what your needs are so we can get things set,” she noted. “It's not a gotcha moment.”